1. Personal details.
Full name
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Address
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Tel
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Fax
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Email
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Parents' Names
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Parents Tel
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Date of Birth
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Age
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Nationality
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2. Education
Name of School/College
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Tel
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Fax
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Qualifications
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Current Course
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Please give details of university/employment plans
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What languages do you speak other than English?
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Please give details of main interests/leisure activities.
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How did you hear about Bacalar Chico?
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3. Experience and Skills
Please give details of overseas travel experience
(please go onto another sheet if necessary)
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Please give reasons for applying for a Bacalar Chico placement, detailing
any special skills, knowledge or relevant experience
(please go onto another sheet if necessary)
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4. Personal History
Please answer yes or no to the following questions. If the answer is yes, please attach details
Have you ever been convicted of any criminal offence?
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Have you ever suffered from any medical, psychiatric or eating disorders?
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Have you ever been hospitalised?
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Do you take regular or intermittent medication?
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Do you have any allergies?
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Do you have any special dietary requirements?
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Please set out (on a seperate piece of paper if necessary any other matters, ailments, conditions or circumstances that are not covered by the above questions which may be relevant, bearing in mind that the placement is in a remote location.
If this information changes before departure date please contact Bacalar Chico NP/MR immeadiately
Reference. Please attach one character reference from your school or employer